Don’t Use Me is a series of articles and social media posts which has a simple message: there is no excuse for transphobia.
On 25th May 2019 the World Health Organization (WHO) announced an important change to its global manual of medical diagnoses: being transgender would no longer be classified as a mental disorder.
Coming 46 years after homosexuality was similarly declassified, this was recognition, a WHO expert said at the time, that being trans is "not actually a mental health condition".
Three years later, the "liberation" that this move supposedly promised trans people is yet to materialise. The WHO had removed "gender identity disorder" from the mental disorders chapter of its diagnostic manual and reframed us as "gender incongruent" in the sexual health chapter. At the time, human rights organisations hoped that this would push governments around the world to drop the requirement that trans people be medically diagnosed before being able to access gender-affirming healthcare and legal gender recognition.
But in dozens of countries – including nine in Europe and Asia, according to the most recent Trans Rights Europe Map – trans people must be sterilised to be legally recognised. In many more, including the UK, trans people who want the correct name and gender on their official documents, or access to gender-affirming healthcare, are forced to be medically diagnosed first with gender dysphoria. By medicalising the process of transition, governments – often going against the professional opinions of doctors – continue to pathologise trans people.
The paradox at the heart of this myth’s persistence is this: While being trans is not a sickness, the way society treats trans people often makes us sick.
And in countries where a gender dysphoria diagnosis is required for trans people to access gender-affirming healthcare, the myth becomes extra sticky. If trans people aren’t mentally ill, why do we need a psychologist’s report before we can have healthcare? Healthcare that, often, cis people can access without being made to jump through these pathologising hoops.
This myth that being trans is a mental illness also persists beyond the finer details of trans-related legislation and healthcare.
Thomas’s experience mirrors that of other trans women. It was "insane" to let trans weightlifter Laurel Hubbard compete in the Olympics; Caitlin Jenner was "sick and delusional" for coming out. Last year, trans comedian Jen Ives went to the conference of anti-trans charity LGB Alliance – also attended by Labour MP Rosie Duffield and Tory MP Jackie Doyle-Price – and was called a "mentally ill pervert".
The paradox at the heart of the myth that being trans is a mental illness is this: while being trans is not a sickness, the way society treats trans people often makes us sick.
Of course, society branding women as mentally ill is nothing new – doctors diagnosed women with "female hysteria" for centuries. And we shouldn’t shame people who live with mental illness, as many trans people do.
The diagnosis of gender dysphoria (which not all trans people experience) is not a mental illness – it is a term used to describe the clinically significant distress some people feel at the difference between their gender and the sex they were assigned at birth. That said, many trans people do have mental health issues.
Why? Discrimination, violence and stigma contribute to trans people having worse mental health outcomes than cis people. Trans people are nearly nine times more likely to attempt suicide in our lifetimes, four times more likely to experience depression, three times more likely to have an anxiety disorder, significantly more likely to use drugs or alcohol as coping mechanisms, and more likely to develop an eating disorder. Research this year found that non-binary people (who may or may not be trans) have the worst mental health of all genders. More than one in two non-binary people worldwide are clinically distressed or struggling.
Often, trans and non-binary people’s mental health can be improved by having better access to resources and support – just like it can for any other group. Housing security, employment that pays a liveable wage and accessible healthcare all hold the potential to improve someone’s mental health and wellbeing. In the UK, one in four trans people have experienced homelessness; a 2018 survey revealed that a third of UK employers won’t hire a person they know is trans; and trans people who want to medically transition will be left on an NHS waiting list for around five years before being given their first appointment at a gender clinic.
For trans people, research shows that gender-affirming healthcare – including counselling, hormones, surgeries, speech therapy and puberty blockers – has a positive impact on mental health.
This was reiterated by a Stanford study this year, which found that trans people who want and take hormones have better mental health than those who want them but can’t have them. The researchers also concluded that if trans teenagers who want to take hormones are given them, they grow up having fewer suicidal thoughts, fewer substance use issues and being less likely to experience a major mental health disorder in adulthood. For trans people, transition – as Lia Thomas has found – can bring happiness.
Many trans and non-binary people know this. Instead of being defined by experiencing gender dysphoria, trans writers and artists increasingly make work about gender euphoria: a powerful sensation of happiness. It can come through being gendered correctly by others, by changing our name or pronouns or hair or the way we dress, or from that magical first post-top surgery swim.
Making gender-affirming healthcare freely available to all who want it, trans or cis or anywhere in between, would go some way towards ending the myth that we are mentally ill. Improving trans people’s material conditions would help, too.
Perhaps in that future, where we get our T from Tesco and everyone is housed and fed, we will stop measuring transness by gender dysphoria and poor mental health. Perhaps in that future, trans people will be defined by our experiences of trans joy.